Diagnostic & Surveillance

Project Component: Strengthening Regional Diagnostic and Surveillance CapacityComponent Description: To provide support to create and render functional a regional laboratory network which aims to enhance access to diagnostic services for vulnerable groups; improve capacity to provide specialized diagnostic services and conduct drug resistance monitoring; and strengthen laboratory based disease surveillance to provide early warning of public health events.

Uganda’s strategy in dealing with epidemics has been as follows:

In the recent past, the East African region has suffered a protean of disease outbreaks that have crossed geopolitical boundaries and caused high morbidity and mortality among its population. These outbreaks include Viral Hemorrhagic Fevers (VHFs), Rift Valley Fever, Cholera, and Pandemic Influenza A (H1N1) among others.

The regional technical working group (Surveillance TWG) on outbreak surveillance and response was established by the EAPHLNP to effectively prevent and control disease outbreaks occurring across borders, mitigate their negative effects by mounting and executing coordinated joint responses across these geographical boundaries.
Joint cross border responses to disease outbreaks face challenges resulting from the bureaucratic delay by governments of the member states. An institutional framework for cross-border surveillance and response for the EAC region was adopted and approved by the member states participating in this project.

Member states have adopted this framework and implemented it, and Uganda has disseminated it at five of the five satellites sites. This framework identified priority diseases that are of regional and international importance and provides a consensus based approach to the surveillance of these priority diseases and response in the event of a confirmed/suspected outbreak.

Implementation of the framework relies heavily on sharing information of occurrence of these diseases among member states in order to enable timely joint response. This framework is now an integral part of the protocol on regional cooperation on health, which was approved by the 16th Ordinary meeting of the EAC Sectoral Council of Ministers on Regional cooperation in Health and also the 26th EAC Council of Ministers on 26th November 2012. During the maiden cross border outbreak surveillance and response meetings, multidisciplinary and multi-sectorial cross border surveillance committees were formed between Uganda and Kenya in 2011 and with Rwanda in 2012.

A mechanism for sharing outbreak related information within the cross-border surveillance zone was also agreed upon. The cross border surveillance committee members were drawn from the bordering districts from both countries. The committee included disease surveillance coordinators, laboratory experts, clinicians, veterinary officers, immigration officials and local administrators.
EAPHLNP is supporting the National Epidemic Surveillance Division being transformed into emerging Emergency Operations Centre (EOC), for implementing the Integrated Disease Surveillance Response (IDSR) strategy within its borders (inter-district but intra-national) as well as across international borders.

This is improving the control for disease outbreaks (timeliness of the response, case fertility rates) that occur in the cross-border setting due to improved coordination and information sharing mechanisms.

At the regional level, Uganda was the only country that met the targeted number of joint outbreak investigations in the financial year 2012/2013. Cholera and Plague outbreaks in Arua occurred across the DR Congo and Uganda border, Cholera and Polio across the Uganda-Kenya Borders, were investigated using the Institutional Framework for Cross Outbreak investigation and response, though DRC is not a participating state in the EAPHLNP.

President Museveni creating awareness about the dangers of eating bats that could cause an epidemic:

The Republic of Uganda is also spearheading the Laboratory Accreditation and Networking (LABANW) component of the EAPHLNP in the region. A technical working group chaired by Uganda was established to provide a forum for laboratory personnel in the East African region to; discuss technical aspects; set objectives; draw common workplans and; monitor overall progress of accreditation and networking in the region.

There is improved diagnostic capacity at the satellite laboratories. Turnaround time for generation of results has been reduced to two days with the supply and installation of 11 GeneXpert machines and 25,000 cartridges.

The World Health Organisation (WHO) standard operating procedures have been uploaded on the web portal (www.eaphln.go.ug) as well as a list of key human resource persons in the laboratory sector in East Africa.

Laboratory Mentors recruited by the EAPHLN and assigned to specific satellite laboratories have assisted greatly in the improvement of quality management systems, diagnostics and mentorship training for management at their sites.

Milestone achievements of the laboratory accreditation and networking technical working group are the regular conducting of regional peer assessments amngst the five EAC countries and the attainment of Supranational Laboratory staus (SRL) by Uganda’s National Tuberculosis Reference Laboratory (NTRL).